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Updates on tea and medical bureaucracy

I get some fantastic comments on this blog and a few of them just have to break out of the comment section. So I’m going to pick up on four of them, two about tea and two about medical bureaucracy.

Tea

If you’re American, you think I already wrote more about tea than is either intellectually or physically possible. But I live in Britain. Tea is the binding force that holds the nation together, and let me tell you it’s looking a little shaky lately, what with Scotland having held a referendum on whether to leave the union and, far more shockingly, so many kids these days getting their caffeine from energy drinks instead of a respectable source like tea. Not to mention the number of tea drinkers allowing themselves to be seduced by fancy coffee and if that isn’t enough the possibility that Scotland will hold another referendum in the (less than immediate) future.

Screamingly irrelevant photo: Fall berries. I’m not sure what they are but I don’t recommend tasting them.

And I’m not sure how the Welsh feel about referendums and secession. Or even whether some purist is going to tell me that the plural is referenda.

So, yeah. We need our tea. And we need to make it right. Which brings me to the point—and yes, there is one. Or two actually. You only had to wait.

J. tells me (and this was in person, not in a blog comment, which is why she’s going by an initial; the tradition may be silly but at least I’m consistent) that I ignored the role of teapots in my last tea post. Sure, I mentioned them, but you can’t make a nice cup of tea, J. says, unless you make it in a pot. Actually, she probably said “a proper cup of tea,” but I was listening to the sense, not the words, sadly. The sense was this: Make it in a cup and it just doesn’t come out right. Even if you only make a single cup, you need to make it in the pot and then pour it into the cup.

Why? Because it’s not a proper cup of tea otherwise, and if it’s not a proper cup of tea it’s not a nice cup of tea. And if it’s not a nice cup of tea, Scotland might just spin out into the North Sea, leaving the northern edge of England a ragged tear (pronounced tare; people may or may not weep about this, but it’s not what we’re talking about) across the land.

That’s not intended, by the way, as a comment on whether Scottish independence is a good idea. I could argue both sides of the proposition with equal passion. But the spinning into the North Sea? That’s just, you know, a fact.

Oh, and the pot has to be warm. Because the tea will brew better.

J.’s of the bone china school of tea drinking. Because it tastes better that way. It doesn’t have to be a fussy little cup and saucer—a mug’s fine—but for her it has to be made of china. Me? I like a heavier mug, but I try not to argue religion with friends.

So that’s one point. And then in the comment section, helenwood wrote about a job she had long ago, working for a tea importer, pouring water over the leaves so the tasters could sip and spit. But that wasn’t what grossed her out—it was that the tea leaves scattered on the warehouse floor, and presumably walked through by one and all, ended up in teabags.

If anything’s going to convert me to leaf tea, that would do it.

Medical bureaucracies

Moving on, then, from a serious topic to the trivia of our lives, we come to what I wrote about medicine in the U.K.

Ianbcross, a doctor who’s worked in the National Health System, commented that the Choose and Book system gives patients a code so they can make an appointment with a specialist online or by phone. “If there are no appointments available,” he writes, “it is up to the hospital to find one for you. You decide whether to accept it or not. This is for routine stuff. If your doc thinks you might have cancer, you get a two week wait appointment from the hospital. Less choice for you, but as soon as they can, they fit you in. Emergencies go directly to hospital, without passing GO, of course.”

Well, this is a guy who knows the system, and his comment made me wonder if I’d misremembered my experiences and Wild Thing’s. So I did what any sane blogger would do: I took a small and unscientific survey (I’ve stolen that phrase; it’s nice, isn’t it?) and came up with the following revelation: Our local surgery (that’s a doctor’s office if you’re American) is all set up so you can use the Click and Book system, but they don’t tell you about it. If you ask to use it, they’re happy to let you use it. But if you don’t already know about it, you can’t ask. So you sit around waiting for that letter.

Unless—as happened to me recently—you get a phone call. From the wrong hospital. But never mind, it was a phone call and it came quickly.

When I acted as an advocate for our neighbor, it wasn’t about getting an appointment but about shaking loose the report from an appointment she’d already had so she could (a) find out what was wrong and (b) do something about it. The doctor had dictated the letter and there it sat, waiting to be typed. And as far as I could tell there it was going to sit and wait until pine trees grew in hell.

The practice manager and I had a leave-it-with-me conversation, and I left it with her until the end of the day, when I called back. Which reminds me to mention that the NHS has a wonderful service called PALS, which stands for Patient Advocacy SomethingWithAnL SomethingWithAnS, not (as it did when I was a kid in New York) the Police Athletic League. I called PALS just after I talked with the practice manager. I suspect it’s owed the credit for getting that letter in the mail. I heard a rumor the service’s funding is going to be cut. I hope it’s not true, because the idea that within an inevitably bureaucratic system are people whose job is to make a nuisance of themselves when things aren’t working for the patient? That’s inspired.

In another comment, Dan Antion reminded me that in the U.S. the first questions anyone medical asks are about your coverage. If you’re not American, you may need that translated: Do you have insurance? Who’s your provider? What plan are you on (secondary translation: does your insurance plan cover this procedure)? And so on. In other words, everyone talks money while you bleed onto the floor, because money is what matters. (Note to the current U.K. government: Are you sure you don’t want to rethink that whole privatization of the NHS thing?)

And if anyone in Britain thinks it’s just the NHS that has unacceptable delays, he tells the story of a friend with a life-threatening condition who needed surgery and was told she couldn’t be seen for six to eight weeks.

The thing about the NHS is that until the current round of disorganizations were introduced, it’s been a unified system, so people talk about unacceptable delays, and newspapers write about them, and word generally gets passed around and everyone’s outraged and wants something done about it, which creates pressure to actually do something. When emergency rooms keep people waiting for more than four hours, it’s considered unacceptable. In the U.S., my father was left waiting in the emergency room for, if I remember right, seventeen hours. With meningitis. At the age of ninety. And he had good insurance. We were furious, but it was business as usual and didn’t tarnish the hospital’s reputation, or the U.S. medical system’s.

as for referendums vs referenda, the OED states both as plural. No caveats, both are equally acceptable.
if it is in the OED I believe it. THis was much to my annoyance the other day when I had to use antennas rather than antennae due to it being in a technical document :-/

One of the lovely things about being retired is that I don’t have to care anymore what the OED, or Web 15 (Webster’s Dictionary, and I don’t remember if it was 15 or 10 or 1.0) says. I do feel the occasional twinge or guilt, or lack of professional pride (which feels very much the same), but I’ve learned to live with it.

You must’ve used predictive text for that and it came out “wine drank tea.” But ignoring that, that sounds exactly like the way a child’s mind works. My mother had one of those immune systems that meant she almost never got sick and I must’ve been in my teens before I realized that being a mother didn’t prevent people from getting sick.

My next door neighbor is a young and still idealistic new doctor. She related the story of finding a fixable tumor within a patient. The patient’s insurance would not cover the simple procedure to remove the tumor, though, because the condition was not life threatening. Flash forward to a year later, and now the tumor is life threatening. But now it is too late to fix the problem, and a few weeks later the patient is dead.
Yes, our system has bad flaws.

A few more comments:
Usually, when the doctors regard your condition as life threatening, you will get excellent, timely emergency care under the NHS. Without that urgency, you may have to wait to be seen/treated. The NHS has definitely become more patient-centred over the past decade, but (despite what the politicians say) the service is rationed.
There is pressure on GPs not to refer patients. Some general practices hold weekly meetings to discuss potential referrals and may come up with another solution before the patient sees a hospital specialist. There was an article recently in the press about GPs being paid NOT to refer patients. I’d guess that the payment was to fund activity in the practice to provide treatment outside hospitals.
Dr Ian Cross

First, I really appreciate your expertise in this, and that you’ll take the time to comment. Second, you could argue (correctly, I think) that health care’s rationed everywhere. In the U.S., the mega-insurance companies ration it quite carefully–sometimes for good medical reasons and sometimes for bad ones. And where people pay for it themselves, it’s rationed by affordability. The issue, then, isn’t whether it’s rationed but how and why.

Of course, it I’d rationed everywhere. There’s the Oregon experiment where citizens were asked to prioritise which diseases received funding. Amazingly schizophrenia rated highly, 4th I think, when most experts thought that it would be much lower. So ordinary people can make rational, unselfish, humanitarian decisions on how to ration care. However, in UK politicians tend to respond to public opinion from pressure groups. For example drugs to extend life in terminally ill cancer patients.
The National Institute of Clinical Excellence NICE tries to bring together experts who examine the scientific evidence for a surgical procedure or a drug. If it is backed by evidence and costs less than £30,000 per QALY (quality adjusted life year), then NICE encourages NHS Trusts to fund it.
So we don’t do varicose veins on the NHS anymore.
We even have local committees to discuss requests for special interventions when there is no appropriate NICE guidance. Phew. It isn’t just a handful of Aspergery senior medics deciding things according to their whims.

The times when I’ve read or heard radio reports on NICE guidelines, my primary response is that I’m grateful not to have to make those decisions. I do understand that they have a set of guidelines that make it a more rational and less emotional process, but it still has to be, somewhere in there, a heavy weight to carry.

I’m not convinced it’s better from a pot, but when J. stopped by today I made it in a pot because she likes it that way. It’s one of those little things we do for friends, right? For myself alone? I’ll make it in a cup.

A beautiful tea pot sure adds to more than just the drink. For me it stands for what I call a home. You know, more than just a place to live. Right now I have a place to live, because I’ve been traveling a lot lately. When I create a home, I will search for the perfect tea pot, and it will surely have a place of honor in my kitchen, where it will be viewable for everyone that I invite to my home.

Agreed. Although mine’s usually on the counter, either among the dirty dishes or on the clean counter waiting to be used again. We’re a little too chaotic here for it to have a place to go on display. In spite of that, I enjoy looking at it–and having one that I do enjoy looking at.